Postoperative Myxedema Coma: A Rare Presentation of Hypothyroidism

Abstract

Myxedema coma is a rare life-threatening form of severe hypothyroidism with physiological decompensation. It occurs as a result of long-standing, undiagnosed, or undertreated hypothyroidism and is usually precipitated by an acute event similar to infection, cerebrovascular accident, myocardial infarction, trauma, cold exposure, surgery, or drug therapy. Patients with myxedema coma are generally severely ill with hypothermia and depressed mental status. It is a medical emergency with a high mortality rate. If the diagnosis is suspected, immediate management is necessary before confirming the diagnosis. Patients with myxedema coma should be treated in an intensive care unit with continuous cardiac monitoring. Initial steps in management include airway management, thyroid hormone replacement, glucocorticoid therapy, and supportive measures. Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread availability of thyroid-stimulating hormone assays. The following presentation is a case of postoperative myxedema coma that was successfully managed with multidisciplinary effort. The patient has had a complete recovery.